A resident may require tube feeding, or enteral nutrition, if they are unable to consume their meals orally. This may be due to reasons such as stroke, oral cancers or gastrointestinal complications. They will receive a liquid drink through a tube which passes directly to their stomach or small intestine.

A resident may rely solely on enteral nutrition or they may use this as a supplement to an oral diet.

There are several types of enteral nutrition:

1. Nasogastric tube – passes through the nose to the stomach. Usually a short term option.
2. PEG – passes directly through the stomach wall into the stomach. An option for people needing long term enteral feeding.
3. PEJ – passes through the stomach into the jejunum. More complicated and generally less common.

There is a large choice of enteral feeding formulas available. They can be disease specific such as formulas for renal disease or gastrointestinal diseases along with formulas varying in their energy density, protein content or fibre content.

A dietitian is able to individually assess each resident to ensure they receive the most appropriate formula for their situation.

Tube feeding can be administered in different ways:

Using a pump – generally used when the feed is given over several hours without stopping. The continuous method is more suitable for residents who are less mobile or are sensitive to large amounts of feeds being administered at once. Continuous feeds can be provided overnight or slowly throughout the day. When a feed is being administered the resident will be less able to move around and therefore this needs to be considered.

Using a syringe – utilised when the feed is given in several ‘meals’ throughout the day. Bolus feeds are normally given 4 – 6 times each day. The advantage of bolus feeding is that the resident is able to be mobile between feeds.

Trouble Shooting tube feeding problems

Diarrhoea:

Possible causes of diarrhoea may include:

• Medications (laxatives/antibiotics) – consider timing and types of medications.
• Formula being administered too fast – consider reducing feeding rate.
• Formula too cold – ensure the formula is room temperature.
• Contamination of the formula (poor hygiene).
• Type of formula being used – consider trialling a change in formula (eg. Less energy dense, more/less fibre).

Nausea/vomiting/bloating/reflux:

Possible causes:

• Formula too cold – ensure the formula is at room temperature
• Formula administered too quickly – try slowing fed or switching from syringe to pump feeding.
• Too much formula being administered during each feed – reduce volume of each feed. Consider an increased number of boluses each day or a more energy dense feed.
• Type of formula being used – consider trialling a change in formula (eg. Less energy dense, more/less fibre).
• Resident lying flat during or after feeding – ensure resident is sitting or lying at an angle of at least 30 degrees during feeding.

Constipation

Possible causes:

• Not enough fluid – increase fluids flushes
• Not enough fibre in the formula – try an alternative feed or add fibre supplements (ensure plenty of water if adding fibre supplements).
• Lack of exercise – encourage gentle movement
• Medications

In summary, enteral feeding can be a daunting experience for residents and facilities, however if planned properly and all circumstances considered enteral feeding can be a simple process that can provide the resident with a renewed quality of life.

A dietitian is able to work with the RACF and the resident to develop a feeding regime that is well tolerated by the resident and realistic for the facility.